Dematiaceous Fungal Keratitis Research Articles

Successful Management of Pythium insidiosum Keratitis Masquerading as Dematiaceous Fungal Keratitis in an Immunosuppressed Asian Male

ABSTRACT Purpose To describe the first case of Pythium insidiosum keratitis masquerading as dematiaceous fungal keratitis in a seropositive male. Case summary A 44-year-old seropositive male previously treated for acute retinal necrosis presented with pain and defective vision in the right eye following a mud injury 5 days back. Presenting visual acuity was hand movements close to the face. Ocular examination revealed a 7 × 7 mm dense, greyish-white mid stromal infiltrate with pigmentation and few tentacles. The clinical diagnosis suggested fungal keratitis. Corneal scraping on 10% KOH and Gram stain revealed slender, aseptate hyaline hyphae. Before culture results, the patient was treated with topical 5% natamycin and 1% voriconazole, but the infiltrate progressed. Culture on 5% sheep blood agar revealed white fluffy, submerged, shiny, and appressed colonies, and Pythium insidiosum was confirmed by zoospore formation. The patient was further managed with topical linezolid 0.2% hourly, azithromycin 1% hourly, and adjuvant drugs. Conclusion This is an uncommon presentation of Pythium keratitis masquerading as dematiaceous fungal keratitis in an immunocompromised male.

Predictive Factors for Resolution of Dematiaceous Fungal Keratitis.

To ascertain the clinicomicrobiological correlation and evaluate the prognostic factors associated with medical resolution in cases of Curvularia, Alternaria, and Scedosporium keratitis. A retrospective review of clinical and microbiological records of culture-proven cases of Curvularia, Alternaria, and Scedosporium keratitis from 2017 to 2019 was performed. Multivariate logistic regression analyses were performed to assess the predictive factors for medical resolution. There were a total of 79 eyes of 79 patients. Among these, there were 56 (70.8%), 15 (18.9%), and 8 (10.1%) patients with Curvularia, Scedosporium, and Alternaria keratitis, respectively. Clinical resolution with medical treatment was achieved in 46 of 56 (82.1%) patients with Curvularia keratitis, 8 of 15 (53.3%) patients with Scedosporium, and 7 of 8 (87.5%) patients with Alternaria keratitis. In comparison between Curvularia and Scedosporium, macroscopic pigmentation [18/56 (32.1%)] of anterior stromal plaque-like infiltrate [20/56 (35.7%)] was clinically more in cases with Curvularia, whereas larger diameter of the infiltrate, P = 0.002, posterior stromal infiltrate (40%), P = 0.03, and hypopyon, P = 0.009, were more common with Scedosporium. Multivariate logistic regression analysis, by backward elimination, showed that maximum dimension of the infiltrate (P = 0.01; odds ratio = 0.52, 95% confidence interval, 0.31-0.86) and presence of a hypopyon (P = 0.02; odds ratio = 0.12, 95% confidence interval, 0.02-0.71) were significant factors that were not favoring medical resolution. Larger size of the infiltrate, posterior stromal involvement, and presence of a hypopyon are poor prognostic indicators among all 3 species. Variation in species is not a predictor of clinical resolution.

The Clinical Features and Prognostic Factors for Treatment Outcomes of Dematiaceous Fungal Keratitis over 9 Years at a Tertiary Eye Care in Northern Thailand.

Dematiaceous fungal keratitis is an important etiology of visual loss, particularly in an agricultural society. From a retrospective review of medical records from 2012 to 2020, 50 keratitis cases of cultured-positive for dematiaceous fungi were presented at a tertiary care hospital in Northern Thailand. The study aimed to identify the isolated causative dematiaceous species using the PCR technique and to explore their related clinical features, including treatment prognoses. Sequencing of the amplified D1/D2 domains and/or ITS region were applied and sequenced. Of the 50 dematiaceous fungal keratitis cases, 41 patients were males (82%). In most cases, the onset happened during the monsoon season (June to September) (48%). The majority of the patients (72%) had a history of ocular trauma from an organic foreign body. The most common species identified were Lasiodiplodia spp. (19.35%), followed by Cladosporium spp. and Curvularia spp. (12.90% each). About half of the patients (52%) were in the medical failure group where surgical intervention was required. In summary, ocular trauma from an organic foreign body was the major risk factor of dematiaceous fungal keratitis in Northern Thailand. The brown pigmentation could be observed in only 26%. Significant prognostic factors for medical failure were visual acuity at presentation, area of infiltrate, depth of the lesions, and hypopyon.

Dematiaceous fungal keratitis: Clinical and microbiologic experience

Objective: The objective was to study the epidemiology, clinical features, and treatment outcomes of dematiaceous fungal keratitis. Design: This was a retrospective, noncomparative, observational study. Materials and Methods: Fifty-nine cases of dematiaceous fungal keratitis seen at tertiary care hospital from January 2017 to June 2018 were analyzed for demographic features, predisposing factors, clinical characteristics, microbiological profile, and treatment outcomes. Statistical Analysis: Mean (standard deviation) and frequency (percentage) were used to represent continuous and categorical variables, respectively. Wilcoxon signed rank test was used for comparative analysis. Results: Of 236 cases of fungal keratitis seen during the study period, dematiaceous fungi were the third most common isolates in 59 cases (25%) after Fusarium (n = 101; 43%) and Aspergillus species (n = 76; 32%). Majority of the patients were adult males (male: female = 2:1) from rural areas (51%) with agricultural occupation (51%). Trauma with vegetable matter was the most common predisposing factor in 27 cases (45.8%). The characteristic macroscopic pigmentation was seen in only eight eyes (13.6%). In our study, 24 (40.7%) patients revealed Curvularia species, followed by Bipolaris and Exserohilum species in 20 cases (33.9%) and 10 cases (17%), respectively. The median time of antifungal therapy was 21 days (interquartile range: 21–41 days). Fifty-four (91.5%) responded to medical therapy, whereas five eyes required surgical intervention. Conclusions: This study signifies the importance of dematiaceous fungi as the important causative agent of fungal keratitis. Medical therapy along with debridement of ulcer alone can be effective in treating patients with superficial infiltrate who seek treatment early.

Causative fungi and treatment outcome of dematiaceous fungal keratitis in North India.

Purpose:The aim of the study is to identify risk factors, clinical characteristics, causative fungi, and treatment outcome of dematiaceous fungal keratitis in North India.Methods:Consecutive cases of culture-proven dematiaceous fungal keratitis between January 2012 and June 2017 were retrieved from the medical record department. Risk factors, clinical signs, and outcome were registered.Results:Eighty-three patients were included. Identified dematiaceous fungal organism were Curvularia sp. (n = 55/83; 66.3%), Alternaria sp. (n = 12/83; 14.5%), Ulocladium sp. (n = 5/83; 6%), Bipolaris sp. (n = 5/83; 6.1%), Scedosporium sp. (n = 3/83; 3.6%), Acremonium sp. (n = 2/83; 2.4%), and Epicoccum sp. (n = 1/83; 1.2%). Male preponderance was reported. The most common predisposing factor was corneal trauma (67.4%). In cases associated with corneal trauma due to vegetative matter, sugarcane was the most common cause. In all, 89% of the patients were more than 30 years of age. The median infiltrate size was 8 mm2. The median time of antifungal therapy was 4.2 weeks (interquartile range [IQR]: 1-25 weeks). Complications were seen in 14 (n = 14/65; 21.5%) patients. Complete resolution of dematiaceous fungal keratitis was present in 27 (n = 27/65; 41.5%) eyes.Conclusion:Curvularia sp. and Alternaria sp. were the predominant pathogenic genera causing dematiaceous fungal keratitis. Among the causative fungi, infections due to Scedosporium sp. were associated with the worst outcomes. Ulocladium sp. and Epicoccum sp. were also identified. Both the species are not reported previously as a causal organism of dematiaceous fungal keratitis from North India.

Commentary: Dematiaceous fungal keratitis: Is it different?

Commentary: Dematiaceous fungal keratitis: Is it different?

Commentary: Dematiaceous fungal keratitis: Importance of ocular microbiology.

Commentary: Dematiaceous fungal keratitis: Importance of ocular microbiology.

Treatment of dematiaceous fungal keratitis in a dog

A 9-year-old castrated male Bichon Frise was evaluated because of a 3-week history of a nonhealing corneal ulcer and corneal pigmentation of the left eye. Ophthalmic examination of the left eye revealed conjunctival hyperemia, corneal neovascularization, corneal edema, corneal ulceration, and central corneal pigmentation. Intraocular structures of the left eye could not be visually examined because of the diffuse nature of the corneal lesions. The right eye had anterior cortical incipient cataracts, nuclear sclerosis, and an inactive chorioretinal scar. Superficial lamellar keratectomy of the left eye was performed for both therapeutic and diagnostic purposes. Histologic evaluation of corneal biopsy specimens revealed dematiaceous fungal keratitis of the left eye, and topical administration of voriconazole was used to successfully resolve the keratitis. Seven months after diagnosis of dematiaceous fungal keratitis, the dog had no clinical signs or history of recurrence of the keratitis. Dematiaceous fungal keratitis should be considered as a possible cause of nonhealing corneal ulceration with heavy pigment deposition in dogs. Results suggested that lamellar keratectomy along with topical administration of voriconazole can be used successfully to treat dematiaceous fungal keratitis in dogs.

Climatology of Dematiaceous Fungal Keratitis

To explore how seasonal climate patterns may influence the epidemiology of human keratomycosis. Retrospective ecological study. The seasonality of 52 episodes of dematiaceous fungal keratitis occurring along the Gulf of Mexico from 1972 to 2004 was examined. The temperature and relative humidity on the date of onset of 36 eyes with Curvularia keratitis was then compared with regional atmospheric conditions. A relative increase in the diagnosis of dematiaceous fungal keratitis occurred during late summer and persisted throughout autumn. The onset of Curvularia keratitis clustered in warm, humid months. Ocular phaeohyphomycosis, including curvulariosis, varies with seasonal weather in the subtropics.

Dematiaceous fungal keratitis presented as a foreign body-like isolated pigmented corneal plaque: a case report

Dematiaceous fungal keratitis presented as a foreign body-like isolated pigmented corneal plaque: a case report

Pigmented plaque presentation of dematiaceous fungal keratitis: a clinicopathologic correlation.

To evaluate the clinical, microbiologic, and histopathologic features of dematiaceous fungal keratitis cases presenting with pigmented, raised, plaque-like infiltrate. Consecutive case series. Microbiology-proven cases of fungal keratitis presenting with a pigmented infiltrate were included in the study. A detailed clinical and microbiological evaluation was performed in all cases. The lesion was removed by superficial keratectomy, and the specimen was subjected to histopathologic examination. Patients presenting with a large infiltrate had penetrating keratoplasty, and the corneal button was submitted for histopathology examination. We enrolled 15 cases in the study. There were 11 men and 4 women. The mean age of the patients was 48.5 years (range 27-68 years). The patients presented to us with duration of symptoms ranging from 7 to 60 days (mean 27.6 +/- 15.6, median 30). The visual acuity was better than 20/200 in 9 (60%) cases. The infiltrate size varied from 4.3 to 64 mm2 (mean 26.9 +/- 16.6, median 22.5). Ten (66.7%) cases had a central infiltrate. The infiltrate was dry and raised, with brown to black pigmentation on its surface. Corneal scrapings revealed septate fungal filaments in all cases and the characteristic brown to black pigmentation of the fungal cell wall in 10 (66.7%) cases. Although there was a significant growth of dematiaceous fungi on culture in all cases, species identification could be done in 3 cases only. Examination of tissue sections revealed a carpet of pigmented fungal filaments on the corneal surface (n = 12, 92.3%) associated with mild to moderate inflammation (n = 11, 84.7%) and tissue destruction. Nine out of 11 cases that had keratectomy resolved with medical therapy. The pigmented plaque-like infiltrate in dematiaceous fungal keratitis consists of surface colonization of pigmented fungal filaments associated with mild to moderate inflammation and tissue destruction of the underlying corneal stroma.

Keratomycosis: clinical and microbiologic experience with dematiaceous fungi

ObjectiveTo assess the significance of dematiaceous fungi in the causation of keratomycosis. DesignRetrospective, noncomparative case series. ParticipantsEighty-eight cases of dematiaceous fungal keratitis seen at the L. V. Prasad Eye Institute, Hyderabad, India from January 1991 through December 1996. InterventionOnly culture-proven cases were analyzed. Main outcome measuresPredisposing factors, clinical characteristics, microbiology, treatment methods, and outcome. ResultsOf 557 cases of fungal keratitis seen during the study period, dematiaceous fungi were the etiologic agents in 88 (15.7%), after Fusarium in 210 (37.6%) and Aspergillus species in 170 cases (30.4%), respectively. Trauma was the most common predisposing factor (47.7%). Fifty-three eyes (61.3%) had the classical clinical picture of yellow-white, dry raised infiltrate with feathery hyphate edges at initial examination. The characteristic macroscopic pigmentation was seen in only 24 eyes (27.27%). Septate branching fungal filaments were identified in 78 smears (88.63%) on light microscopy, of which 5 (5.7%) also showed the presence of bacteria. Curvularia species dominated the spectrum (22.7%). Treatment was started in 48 eyes with topical antifungal agents, whereas 37 received both oral and topical antifungal agents. Outcome data were available for 68 cases. Forty-nine (72%) responded to medical therapy, whereas 13 eyes required therapeutic penetrating keratoplasty and 6 eyes had to be eviscerated. ConclusionsThis is the largest series of keratitis caused by dematiaceous fungi reported to date. It clearly brings out the clinical importance of this group of corneal infections.

Macroscopic Pigmentation in a Dematiaceous Fungal Keratitis

The diagnosis of fungal keratitis can be difficult and is often delayed. The distinction between moniliaceous and dematiaceous (pigmented) keratomycoses is not commonly possible on clinical examination. We report a case of a Curvularia lunata fungal keratitis in a 40-year-old patient who presented with diffuse brown pigmentation throughout the ulcer bed. Histologic staining and growth on Sabourad's dextrose agar demonstrated the brown pigmentation characteristic of this pigmented fungus. We call attention to this clinical pigmentation as a helpful clue in the detection of dematiaceous fungal keratitis.

Dematiaceous fungal keratitis. Clinical isolates and management.

Clinical and laboratory features of 16 cases of keratitis that were caused by dematiaceous pigmented fungi are reported. Management, including the treatment of nine cases with Natamycin (Pimaricin), resulted in corneal healing in 14 cases, and therapeutic surgery in two cases.